Account Placement

Please read our Terms and Conditions before completing the form.Begin with the following service:
Immediate Personal Collection
Forward Now to Attorney
Send 10 Day Free Direct Demand Letter
Please Have Account Manager Phone Me
Debtor:
Contact(s):
Address:
City:
State:
Zip Code:
Phone Number:
Debtor Fax Number:
Email Address:
Account Number:
Amount Owing:
Cell/Mobile:
Principals of Debtor:
Debtor's Bank:
Additional Information:
Please email or fax (972-580-9089) a statement of account to support the balance placed, as well as any credit application, personal guaranty and invoices you have on this debt.
Creditor:
Address:
City:
State:
Zip Code:
Phone Number:
Creditor Contact:
Email Address:
To add your trade information on this account to the NACM database please check this box and fill in the blanks:
Year Opened:
Last Sale Date:
Payment Terms:
High Credit:
Account Balance:
Actual Balance:
Current:
1 to 30:
31 to 60:
61+:
Paying Record:
Discounts:
Pays When Due:
Days Slow:
Comments:
Thank you for your placement! It will receive our immediate attention and best efforts. If you have any questions or need additional information please email or call us 972-518-0322.By submitting this form you agree to our terms and conditions as outlined and to notify NACM MidAmerica promptly of any payments you receive directly from or contact you have with the debtor. Commissions are governed by the date NACM MidAmerica receives notification.
Guarantor Name:
Guarantor Address:
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Protection Code:*
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